First Author: M.Gatcu RUSSIA
Co Author(s): M. Melikhova
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Determine clinical and diagnostic criteria of dome-shaped macula (DSM) and its complicated forms
determine the most significant criteria of complicated and uncomplicated forms of dome-shaped macula on the results of clinical and instrumental methods of examinations
17 patients (29 eyes) were examined, 7 (41%) of them were men and 10 (59%) were women at the age of 23-70 years (average age 49.9±3.93). All patients had complete ophthalmological examination, including visometry, ophthalmoscopy, biometry, OCT of high resolution (EDI-OCT) and angio-OCT, ultrasound examination in mode of B-scan, fluorescent angiography (FA), indocyanine green angiography (ICG), magnetic resonance imaging of orbits (MRI).
94% of patients had myopia. The value of axial length varied from 23.85 to 29.19 mm, on the average 26,5±0,33. According to best-corrected visual acuity all cases were divided into groups: I–0,01-0,1 (3 eyes, 10.3%); II-0.2-0.5 (12 eyes, 41.4%); III-over 0,5 (14 eyes, 48.4%). In 18 eyes (62.1%) serous retinal detachment (SRD) was revealed. In 37.9% of cases (11 eyes) uncomplicated form of DSM was determined. Convex elevation of macula was visualized on EDI-OCT mainly in vertical scans. Thickness of choroid varied from 75 to 370 µm (average 168.5±15.2). According to the data of B-scan in macular area protruding formation of hyperechonic density was determined without possibility of precise differentiation of its layers. On FA on 6 eyes with SRD it was impossible to reveal its origin. On 4 eyes the spots of liqueige of fluorescein by type “ink-blot” and “smoke-stack” were determined, which are typical for central serous chorioretinopathy. On 6 eyes diffuse accumulation of dye was revealed, related to choroidal neovascularization (2eyes) or polypoid vascular changes (4eyes) confirmed with ICG and angio-OCT. MRI of orbits confirmed dome-shaped abnormal posterior pole of eyes in all cases and made it possible to perform differential diagnostics of DSM with choroid neoplasms.
Clinical and diagnostic criteria of dome shaped macula are recommended to consider convex elevation of posterior pole by means of local thickening of sclera layers, confirmed with EDI-OCT in patients mainly with high myopia. The main reasons of complicated course of DSM with SRD are polypoid vascular changes in choroid, choroidal neovascularization and central serous chorioretinopathy. MRI of orbits gives the possibility to visualize in the most precise way dome-shaped abnormal posterior pole of the eye. It is necessary for differential diagnostics of DSM and neoplasms of choroid.